Background: Hodgkin lymphoma (HL) survivors are at increased risk of cardiovascular diseases (CVD) due to former treatment. In 2013, we started survivorship care for 5-year HL survivors at Dutch BETER clinics, where screening for CVD and associated risk factors according to uniform guidelines was implemented. Eligibility criteria for cardiovascular screening include: 1) age at HL treatment ≤60 and current age ≤70 years 2) treatment with mediastinal radiotherapy with/without anthracyclines (irrespective of dose) or anthracycline cumulative dose equivalent to doxorubicin ≥300 mg/m2. We assessed adherence to screening guidelines and the yield of previously undiagnosed (risk factors for) CVD in the screening program.
Methods: Data on patient and treatment characteristics and cardiovascular screening were collected retrospectively from medical records for 5-year HL survivors who visited the BETER outpatient clinic at three university medical centers in 2013-2020.
Results: We identified 240 patients, of whom 184 (76.7%) were eligible for cardiovascular screening (mean age at start follow-up 47.7 years). In eligible patients, CVD screening was performed according to the guidelines: physical examination (65.8%), lipids (86.4%), (NT)proBNP (82.1%), glucose (85.3%), electrocardiogram (97.3%) and echocardiography (96.7%). Screening yielded the following new diagnoses in eligible patients (Figure 1): hypertension (4.3%), dyslipidemia (10.3%), heart failure (1.1%), cardiomyopathy (1.6%), coronary artery disease (1.1%), conduction disorder/dysrhythmia (4.3%), pericarditis (0.5%), mild aortic or mitral valve insufficiency or stenosis (31.0%) and severe aortic or mitral valve insufficiency or stenosis (2.7%). Left ventricular ejection fraction (LVEF) was available for 87 eligible patients, of whom 9 (10.3%) had a LVEF <50%. Echocardiography was also performed in 32 out of 56 (57.1%) non-eligible patients: 21.9% had a new mild valve dysfunction, 3.1% had a new severe valve dysfunction.
Conclusion: Adherence to the screening guidelines was reasonable. A substantial number of new (risk factors for) cardiovascular conditions were diagnosed in the Dutch BETER screening program for HL survivors, also in non-eligible survivors. Future studies are needed to confirm findings in a broader population and to determine whether screening is effective in reducing burden of disease associated with late cardiovascular effects and in improving survivor’s quality of life.